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Effects of herbal medicine for xerostomia in head and neck cancer patients: an observational study in a tertiary cancer hospital

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Abstract

Purpose

More than 80% head and neck cancer patients endured radiotherapy-induced xerostomia which impacts their quality of life (QoL). This observational study evaluated the effect of herbal treatment on head and neck cancer patients’ xerostomia and QoL.

Methods

Head and neck cancer patients were recruited from July 2016 till March 2017 at National Cancer Institute, Ministry of Health, Malaysia. All study participants continued their standard oncology surveillance. Treatment group participants additionally received Chinese herbal treatment. The assessments included unstimulated salivary flow rate (USFR), stimulated salivary flow rate (SSFR), and QoL questionnaire.

Results

Of 42 recruited participants, 28 were in the treatment group and 14 were in the control group. Participants were mainly Chinese (71.4%), stage III cancer (40.5%), and had nasopharynx cancer (76.2%). The commonly used single herbs were Wu Mei, San Qi, and Tian Hua Fen. Sha Shen Mai Dong Tang, Liu Wei Di Huang Wan, and Gan Lu Yin were the frequently prescribed herbal formulas. The baseline characteristics, USFR, SSFR, and QoL between control and treatment groups were comparable (p > 0.05). USFR between control and treatment groups were similar throughout the 6-month study period. SSFR for the treatment group significantly improved from 0.15 ± 0.28 ml/min (baseline) to 0.32 ± 0.22 ml/min (p = 0.04; at the 3rd month) and subsequently achieved 0.46 ± 0.23 ml/min (p = 0.001; at the 6th month). The treatment group had better QoL in terms of speech (p = 0.005), eating (p = 0.02), and head and neck pain (p = 0.04) at the 6th month.

Conclusion

Herbal treatment may improve xerostomia and QoL in post-radiotherapy head and cancer patients.

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Abbreviations

Gy:

Gray

IQR :

Interquartile range

M :

Mean

NCI:

National Cancer Institute

QoL:

Quality of life

SD :

Standard deviation

SSFR:

Stimulated salivary flow rate

T&CM:

Traditional and complementary medicine

USFR:

Unstimulated salivary flow rate

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Acknowledgements

The authors would like to thank the Director of Health Malaysia for permission to publish this paper. We thank the Director of National Cancer Institute, Malaysia, for supporting this research. Appreciation also goes to Professor Jeffrey E. Terrell (University of Michigan, USA) for sharing his QoL questionnaire. We appreciate the research support provided by Dr. Foo Yoke Ching (Subang Jaya Medical Centre, Malaysia), Dr. Wong Wei Kong, Mr. Teng Chee Wi, and the nursing team at our unit (namely Ms. Yuhanis Mat Nasir and Ms. Son Hui Wen).

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Authors and Affiliations

  1. Traditional & Complementary Medicine (T&CM) Unit, National Cancer Institute (NCI), Ministry of Health, Prescint 7, 62250, Putrajaya, Malaysia

    Ren Jye Lim, Wan Najbah Nik Nabil, Li Xian Han, Jia Ying Gong & Kun Ling Ho

  2. First Clinical Medicine College, Jiangsu Province Hospital of Traditional Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, 138 Xianlin Road, Nanjing, 210023, People’s Republic of China

    Ren Jye Lim & Li Xu

  3. Pharmacy Department, National Cancer Institute (NCI), Ministry of Health, Precinct 7, 62250, Putrajaya, Malaysia

    Wan Najbah Nik Nabil, Si Yan Chan & Jia Ying Gong

  4. Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources, College of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan

    Si Yan Chan

  5. Department of Radiotherapy and Oncology, National Cancer Institute (NCI), Ministry of Health, Prescint 7, 62250, Putrajaya, Malaysia

    Yoke Fui Wong

  6. Cancer Centre, Tung Shin Hospital, 102, Jalan Pudu, Bukit Bintang, 55100, Kuala Lumpur, Malaysia

    Yee Siang Shew

Authors
  1. Ren Jye Lim
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  2. Wan Najbah Nik Nabil
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  7. Kun Ling Ho
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  9. Li Xu
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Contributions

Study design: Dr. Lim Ren Jye, Wan Najbah Nik Nabil, Dr. Wong Yoke Fui, Dr. Xu Li. Data acquisition: Dr. Lim Ren Jye, Dr. Wong Yoke Fui, Han Li Xian, Gong Jia Ying, Ho Kun Ling, Dr. Shew Yee Siang. Quality control of data: Chan Si Yan, Wan Najbah Nik Nabil, Han Li Xian, Gong Jia Ying. Data analysis and interpretation: Chan Si Yan, Wan Najbah Nik Nabil. Manuscript preparation: Dr. Lim Ren Jye, Wan Najbah Nik Nabil, Chan Si Yan. Manuscript editing: Dr. Lim Ren Jye, Dr. Xu Li.

Corresponding author

Correspondence to Ren Jye Lim.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study (involving human participants) were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants in the study.

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Lim, R.J., Nik Nabil, W.N., Chan, S.Y. et al. Effects of herbal medicine for xerostomia in head and neck cancer patients: an observational study in a tertiary cancer hospital. Support Care Cancer 27, 3491–3498 (2019). https://doi.org/10.1007/s00520-019-4646-2

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